www.irishheart.ie
www.stroke.ie
WHAT IS A STROKE
AND HOW TO
TREAT STROKE
One in five people have a
stroke at some time in their
life. Stroke can strike at any
age. It could happen to you, a
friend or family member.
Knowing what a stroke can
do to a person can help to
reduce its impact.
If the right
actions are taken
quickly after a stroke,
a person may not have
major long term
disability.
1
Until recently many people, including doctors,
believed that little or nothing could be done after a
person had a stroke.
We now know that strokes can be treated. If the right
actions are taken quickly after a stroke, a person may
not have major long term disability.
Recognising the symptoms of stroke and getting
medical treatment immediately is important.
This booklet explains:
• What stroke is.
• What causes stroke.
• How stroke can affect a person’s life.
• How stroke is treated.
What is a stroke?
“I woke up and suddenly I had a pain in my head. I
couldn’t speak properly. I felt as though my ability to
speak was just going from me. Then my sight went for
a couple of minutes.”
Marie Walsh, 34, Dublin.
A stroke is a brain attack. It is caused by an
interruption of the blood supply to part of your brain.
If your brain stops getting important nutrients and
oxygen from your blood, your brain cells can become
damaged and die.
This can affect different parts of your body. For
example, if a stroke damages the part of your brain
that controls the movement of your limbs, you may
not be able to move one of your arms or legs.
A stroke can also affect mental processes such as how
you feel, think, communicate, or learn.
2
How do you recognise a stroke?
“On the third morning since my headache began I
woke up and I had no power in my left leg. I began to
think that something more serious was going on. ”
Trish Gavigan, 41, Mullingar.
How to Act F.A.S.T.
A simple test can help you recognise a stroke:
Face:
Has the person’s face fallen or
drooped on one side? Can they smile?
Arm:
Can they raise both arms and keep
them there?
Speech: Is the person’s speech slurred?
Time:
It is time to call
999 if you see
any single one
of these signs.
Other stroke symptoms include:
• Numbness, weakness, or paralysis on one side of
the body.
• Slurred speech, difficulty thinking of words or
understanding other people.
• Confusion.
• Sudden blurred vision or sight loss.
• Being unsteady on your feet.
• Severe headache.
FACT: About one third of strokes in Ireland happen
to people under 65 years of age.
3
What causes a stroke?
• Over 80 percent of strokes are caused by a blockage
in an artery supplying blood to the brain. This is
known as an ischaemic stroke. There are three main
types of ischaemic stroke:
1. A blood clot that forms in a main artery to your
brain.
2. A partial clot that may form in your heart or the
blood vessels of your neck. This partial clot can
be carried in your bloodstream to your brain
and get lodged in an artery. This is a cerebral
embolism.
3. A blockage that occurs in the tiny blood vessels
deep in your brain. This is a lacunar stroke.
• Up to 20 percent of strokes are caused by a bleed
into your brain from a burst blood vessel. This is
called a cerebral haemorrhage.
• A transient ischaemic attack (TIA) or mini-stroke is a
sudden and brief disturbance of your brain caused
by small clots. Stroke symptoms from a TIA last less
than 24 hours before going away.
TIAs do not cause any long term damage. However,
they are a serious warning sign that you may have a
full stroke in the near future. Approximately 10
percent of people with a TIA will have a stroke within
a week and 20 percent of people will have a stroke
within a month. TIAs should not be ignored and
urgent medical attention is required.
Cerebral
haemorrhage
Ischaemic
stroke
4
FACT: Risk of stroke is much higher for people who
have had a stroke or TIA before. About 10% of
people who have a stroke will have another stroke
in the next 12 months.
“They found a hole in Michael’s heart. That was the
problem. A blood clot went through the hole that went
to his brain leading to the stroke”.
Therese McGovern talking about her husband
Michael McGovern (39), Longford.
10% of
people who have
a stroke will have
another stroke
within 12
months.
5
Why does a stroke happen?
It may not be obvious why someone has had a stroke.
Contrary to popular belief, stress – either long-term or
after a sudden event – is not a major cause of stroke.
A stroke can happen to anyone. Some people are at
greater risk of stroke for reasons beyond their control,
such as their age and family history. Research shows
that people from Asian, African and African-Caribbean
communities are more likely to have a stroke.
The good news is that by making small changes to
your lifestyle and by taking medicines for certain
conditions as directed by your doctor, you can reduce
your risk of stroke.
Read more on how to prevent a stroke in our leaflet
Preventing stroke.
To reduce your risk of stroke:
• Don’t smoke.
• Be physically active on a regular basis.
• Be a health weight.
• Cut down on salt and fatty foods.
• Eat plenty of fruit and vegetables.
• Control your blood pressure and cholesterol
levels – get your doctor to check them regularly.
• Don’t drink too much alcohol.
• To find out more about reducing your risk of stroke,
see our range of information leaflets: Lose weight,
Quit smoking, Be active, Healthy eating, Manage
your blood pressure, A healthy cholesterol,
Manage your stress and Time to cut down on salt
or contact the National Heart and Stroke Helpline
on Locall 1890 432 787.
FACT: Untreated high blood pressure is the
biggest single risk factor for stroke.
6
Is there any treatment for
stroke?
The stroke services in a hospital can help improve
your recovery after a stroke. Stroke services can start
medical care early and put a plan in place to reduce
your risk of further strokes.
Drug treatment in the early hours after stroke may
also help some people. Treatments such as the clotbusting drug thrombolysis aim to break up the blood
clot with powerful blood thinners.
Do people recover after a stroke?
The brain needs time to heal and recovery can take
many months. Recovery is different for each person.
Some people may recover and have only a slight
disability. Other people may have more serious
disabilities. In general, most recovery is made in the
first year, but you can still make progress after this
time.
Unfortunately, some people will not recover from a
stroke. People who are dying as a result of a stroke
should be given end-of-life care.
FACT: Early diagnosis and treatment for stroke
patients can mean the difference between life and
death or mild and severe disability for the rest of
their lives.
7
Stroke treatment in the
hospital
“At the hospital I was met by the stroke physician. I
had no pain and I wasn’t frightened but they told me
my blood pressure was sky high. I was moved into
intensive care for a few days. Then I was moved to the
high dependency unit for three or four more days.”
Seamus Mills, 62, Artane, Dublin.
When you come to hospital after having a stroke you
may be assessed in the emergency department.
This assessment is essential to ensure you get the
correct emergency treatment. The assessment will
check:
• What type of stroke you had, the area of your brain
that was damaged and how serious the damage is.
• The condition of your heart and lungs.
• Problems you may have with swallowing.
You may then need to have a number of other tests
including a brain scan, blood tests, blood pressure
tests and an electrocardiogram (ECG).
These tests should be carried out as soon as possible.
The earlier your stroke is diagnosed the better chance
you have of making a good recovery.
Clot-busting drugs
Some strokes can be treated by thrombolysis, a clotbusting drug. This drug treatment is only effective if
received within 4 1/2 hours of the stroke starting.
Thrombolysis is not suitable for everyone. Doctors
should check if it would be a good treatment for you.
8
You may need
to have a number of
tests including a brain
scan, blood test, blood
pressure test and an
electrocardiogram
(ECG).
9
Swallowing
Difficulties swallowing are common in the first few
days after stroke. If you find it hard to eat or drink, you
may be referred to a speech and language therapist
for an assessment and you might have another x-ray
called a videofluoroscopy. While you are waiting to
be assessed you may be given fluids through an
intravenous drip . You might also be given insulin to
keep your blood sugar levels stable. Some people will
need to have a feeding tube inserted until it is safe for
them to eat and drink.
FACT: It is estimated that more than 50,000
people in Ireland are living with stroke.
Hospital tests explained
Blood pressure: High blood pressure is the most
common cause of stroke. Your blood pressure will be
checked immediately. Doctors will give you medicine
if you need it.
ECG (electrocardiogram): Irregular heart rhythms
can increase your risk of stroke. This test checks your
heart for unusual rhythms.
Blood tests: Samples of blood are taken to check
your cholesterol levels, your blood’s ability to clot and
your blood sugar levels.
Brain scan or CAT scan (computerised resonance
imaging): This is an x-ray of your brain. You should
have a brain scan within 24 hours of having a stroke.
MRI scans (magnetic resonance imaging) give a
very detailed picture of your brain. For this test you
will lie in a large tunnel-shaped scanner.
10
Carotid doppler ultrasound detects blockages in the
carotid artery (in your neck) which may have caused
the stroke. A probe is placed on the artery on your
neck to check the blood flow.
Echocardiogram (Echo): A probe is moved over your
chest to check the way your heart is working and to
look for any problems.
Chest x-ray: This will help show the condition of your
heart and lungs.
Videofluoroscopy Swallow Test: A swallow test may
be carried out when you come to hospital. You might
have another x-ray called a videofluoroscopy if you
continue to have difficulties swallowing. This x-ray
tests what food and drink you can swallow
safely so that food and liquids don’t get
lodged in your windpipe and lungs.
11
Stroke unit and stroke team
After a stroke you should be cared for in a specialist
stroke unit. A stroke unit is a separate area of a
hospital ward for stroke patients. It is staffed by a
stroke team of doctors, nurses and therapists. If the
hospital does not have a stroke unit you may be cared
for in a general medical or rehabilitation ward.
In hospital, you should be cared for by a doctor who is
an expert in stroke. This could be a geriatrician (a
doctor who cares for older people), a neurologist or a
rehabilitation physician.
Registrars and junior doctors will check on you
regularly. A team of nurses will also care for you.
You must be closely monitored in the days and weeks
after your stroke as complications can occur.
Your brain needs time to heal so nurses and doctors
will work to prevent any complications. Once you are
stable you will be assessed by a rehabilitation team.
Rehabilitation should start soon after you come to
hospital and continue throughout your hospital stay.
The rehabilitation team includes speech and language
therapists, occupational therapists, physiotherapists,
dieticians, nurses, psychologists and social workers.
They work together to help you make the best
recovery possible.
For more information on rehabilitation read our
Stroke Rehabilitation leaflet.
FACT: Acute rehabilitation is available to just one
in four people with stroke in Ireland.
12
Medical terms related to
stroke
Aneurysm
This is a permanent abnormal balloon-like bulging of
an artery wall. If an aneurysm bursts in an artery or
blood vessel in your brain it will cause a haemorrhagic
stroke.
Aphasia
Aphasia is a difficulty with language caused when
areas of your brain that control language become
damaged. Aphasia can affect the ability to talk or
understand what is said, as well as the ability to read
and write or spell, or understand spoken or written
language. A person with aphasia may also have
trouble with numbers or facial expression and
gesture. Aphasia varies in type and severity. It does
not affect your intelligence and can change over time.
Apraxia and dyspraxia
An inability to coordinate movements, because of
damage to the brain, even though there is no damage
to the muscles needed for the movement.
Arrhythmia
An irregular or unpredictable heart beat.
Atrial fibrillation (AF)
An abnormal heart rhythm where the pulse is
irregular. AF can cause blood clots.
Cerebellar stroke
A stroke that strikes the cerebellum area of your brain,
which controls balance and coordination.
13
Cerebrovascular
This is a term for the blood vessels of your brain. A stroke is a cerebrovascular accident.
CT scan
Computerised tomography or CT scan is a series of
x-rays at different levels of your brain.
Dysarthria
Dysarthria occurs when the muscles you use for
speaking are weak. People with dysarthria may have
slurred speech or their voice may become soft or
weak.
Dysphagia
Difficulty with swallowing.
Embolic stroke
A stroke resulting from the blockage of an artery
by a blood clot (or embolus).
Haemorrhage
Bleeding into or around your brain.
Hemiparesis
Muscle weakness down one side of your body.
Infarct
The area of dead brain cells caused by disruption of
the blood flow to your brain.
Intracerebral haemorrhage
A stroke caused by bleeding within your brain.
Ischaemia
An interruption or blockage of blood flow to your
brain.
14
Lability
An uncontrollable outburst of emotion, such as
laughing or crying without real cause. It may only last
a few weeks, or continue for a long period.
Penumbra
An area of surviving brain cells surrounding the initial
site of brain damage from stroke. The brain cells in the
penumbra are at risk of permanent damage, but are
not yet irreversibly damaged.
Perseveration
Getting stuck on one idea, action or response.
Rigidity
Loss of flexibility in thinking or movement.
Subarachnoid haemorrhage
A stroke caused by bleeding usually from an
aneurysm. The bleeding usually occurs into the
cerebrospinal fluid, the protective fluid layer around
your brain.
Transient Ischaemic Attacks (TIAs)
TIAs, are temporary interruptions of the blood supply
to an area of your brain, often caused by a carotid
stenosis (narrowing of the artery). A TIA can last up to
24 hours, but most last only a few minutes and cause
no permanent damage or disability. A TIA is
sometimes called a mini stroke.
15
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Registered Charity Number: CHY 5507
Source Code: APP00248
Making
lifestyle changes
can reduce your
risk of stroke.
Irish Heart Foundation,
50 Ringsend Road, Dublin 4
Phone: +353 1 668 5001
Fax: +353 1 668 5896
Email: [email protected]
Heart and Stroke Helpline:
Locall 1890 432 787
Monday to Friday 10am to 5pm
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www.irishheart.ie
www.stroke.ie
Funding:
The Irish Heart Foundation is the national charity
fighting heart disease and stroke and relies on
charitable donations for 90 per cent of its funding.
We support, educate and train people to save lives,
campaign for patients, promote positive health
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information. We need your support – through
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This booklet has been funded by an unrestricted
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The information provided by the Irish Heart
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Registered Charity Number CHY 5507
2013